carolyn swickard

Here's mine too - if it will help anyone. Very difficult to get everyone through and despite telling them it is THEIR responsibility - you wind up doing the lion's share of it in order to get it done. Blood Bank Competency 2014.xls Blood Bank Skills 2014.xls

We are just beginning to approach this subject here too - For several reasons we have been slow to change - 1. Complex policy difficult for generalists to remember over time - easy to miss one that "should have been done" 2. Hard to remember why a Fetal screeen may be "very" positive when they no longer remember much about Rh neg (weak D positive). 3. We are in a region that doesn't have an abundant supply of Rh negative units anyway - tough to justify using them on a Rh pos Weak D when a real Rh neg might need them desperately. We had a looooong period of A neg shortages this year during the flu season. I do realize that the reagent themselves have changed over time, but the real change for us has been going to solid phase testing on the ECHO. Weak Ds all come out 4+ positive anyway. In tubes that may be a 2-3+ positive, sometimes weaker, but not on solid phase. I am thinking about keeping the weak D testing the same, but changing the Interpretation of the ABORh results from Rh Pos to Rh negative in my computer system. That way, we don't forget what Weak D is all about, we know the reactivity of the pt's blood type and can expect the problems on Fetal Screens (or skip them all together on these pts and go straight to Fetal Stains). We wouldn't have to remember to do the Weak D testing only on Rh neg babaies of Rh neg moms - sure to be forgotten once or twice! We are going to have a meeting soon with the OB docs - they will be the ones most affected by the change - and ask them what they want to do. I'm not sure about asking the pts what they want to do (from an earlier post) but I can see we are going to have to ask the Drs what they want to do when it comes to RhIg administration to the few pts that convert from Rh pos now to Rh neg in the future. Canned comments would be good - I liked some of the wording on that earlier post too. Some may feel this is a waste of testing - but it isn't very many pts anymore anyway and I would just rather "know" about these pts up front anyway. Anybody else feel the same way? Also - even though the reagent manufacturers are trying real hard - do the Anti-D reagents still react with the occasional true Partial D with a strong positive reaction? I thought I understood that to still be the case. These are the pts you really wish would come out a clean Rh neg. Oh well - never a perfect world. I would love to hear from anyone still in the same position as us.

Truely sad for the world of professional Blood Bankers and his family and friends too. He was an incredible contributor to the knowledge base and the current state of Immunohematology.

Third party providers can be notoriously difficult to get information from - at least ours is. At a minimun, if you hospital Lab is Joint Commission accredited, they will want to see documentation that your Medical Director is aware of and has reviewed all the policies and procedures of the perfusionist service doing the work on cell savers for you. Documentation of QC/QA and competency will probably be along shortly, if they do not already do that part when they inspect the hospital (again, if your hospital is Joint accredited). The accreditation agencies do seem to want the Blood Bank to be responsible for this stuff, but it can be very difficult to get unless you have the power and authority of hospital administration behind you. Good luck.

Does your morning commute involve driving?! Studying must be worse than texting!

And you can put the thermometer in a tube, add saline to the top of the well only and then seal with parafilm. You have to occasionally replace the parafilm and refill the tube, but we have used this method for years and it works very well.

If the national saline shortage is still in place - that is probably why they are asking. We were doing a hospital wide survey to make sure we knew what things normal saline had to be used for (no alternatives) and what things they could substitute other fluids for to infuse.

Yes - when we order special screened units from our distributor - UBS, El Paso, they screen and label the units. There is extra charging for this service. We rescreen the units here, but it is much faster than searching our own inventory - especially since our distributor is doing a lot of prescreening now and many of the antigen negative units are already gone. They hold them in stock at the center and have a very fast response time for antigen negative unit requests.

sorry - here is the rest of it If I can ever figure out how to attach something in this new layout, I would be happy to share our form and SOP, otherwise, just email me at carolyn.swickard@lpnt.net and I will try and get it to you. Our only problem lately is that, now that we are essentially a "stabilize and ship" hospital, we are having a little more difficulty following through with full pt ID if the pt is shipped before they are fully identified here. This is something Admissions needs to follow up on, as the pt's full EMR should have a correct name on it eventually.

You can use a two levele system, if your computer system has an Emergency Release module (Meditech does too). Level 1 - pt is not identified and is not in the computer - use a single Emergency Release form that you place unit number stickers on - save 2 more stickers (if possible) and 3 segments. Save 2 segments and 1 sticker as usual (for the 14 day unit segment storage), place 1 sticker on the form and place 1 sticker on a tube with the last segment. The form has places for date/time, tech initials and then the Dr's signature, etc. Very fast and can be used for anyone - identified or not - though one always hopes for full pt identification at a slightly later time. (We have recently discovered that now that we are essentially a "stabilize and ship" hospital, it is much harder to follow up and get the full ID on the pt!) Level 2 - pt now identified and has been entered in computer - save 3 segments and 2 stickers, use Emer Release blood bank computer module as designed, save 2 segemnts and 1 sticker as above and save 1 segemt and 1 sticker for crossmatching post antibody screen.

I agree with R1R2 - at least show that there is a cold there (at least do a cold screen) before assuming an unclear panel is just a "cold". Always check the heterozygous vs. the homozygous patterns first too. I have seen way too many weak antibodies over the years that did not fit a perfect panel pattern, but were anything but "just a cold". Prewarming is a weakened reaction system without any help from the current enhancement medias and it is perfectly capable of missing a bunch of stuff. I did have a reference lab tell me once that you could "prewarm" with enhancement medias too - "just prewarm the media too" and we have done some of that over the years, but not everyone does.

We use the Typenex bands - one for each new specimen. The RN removes old bands at need, if they draw the patient for a new specimen, or at discharge. We also have a Phleb team - they also remove any old bands if drawing a new Blood Bank specimen. Patients themselves frequently remove any band on their arms when they leave - even if told to retain the Blood Bank armband (even when they read and sign a paper telling them to leave the band on)! Oh well.....

We screen the pt for their antigens and decide based on that. If they have Anti-E or Anti-c and are also E and/or c negative - they get R1R1 units. If they have Anti-C or Anti-e and are also C and/or e negative - they get R2R2 blood. This is the only prophylactic screening we do, but it works well based on the frequency of exposure to the opposite antigens that would occur if you ignored it. (Little c at 70%+ when you screen only for E, and Little e at 98% when you screen only for C). Issit and the AABB Manual seem to be split on the subject, so we went with careful. We see so many Anti-Es that we keep some R1R1 units around all the time for use on these pts. Our blood distributor gets the R2R2 units very efficiently, so we just order those at need.

I don't think thawed plasma is recommended for that use. The 17th AABB Manual, Ch 23 indicates Fresh Frozen Plasma should be used. Because smaller volumes are used, no need starting out with the lower coag factor levels present in thawed plasma, even though thawed plasma works well in adults.

But oh soooo common. I think all of us have heard the "Just give them O Neg!" line at one time or another. Still - I am woefully ignorant of most Micro questions too - don't know how ignorant I might sound to them!

We usually start with 2 units of O Neg, but we move to type specific as soon as we have a qualified Blood Bank specimen (banded, correctly labeled). If unable to obtain a Blood Bank specimen, we would switch to O Pos within 4 units.

Quote: By "We are more likely to have a question on the pheresis split letters (A-G) for FFP than anything else - Meditech does show that letter." do you mean the unit division that is the 7th and 8th characters of the product code? Yes, that is exactly what I meant. Meditech prints that letter at the end of the DIN on all paperwork.

We do not print out the checksum digit or the flag characters on any of our Blood Bank records (HCA Meditech), though the barcode reader recognizes and uses the checksum digit to determine correct input. Our blood supplier (UBS) does use the flag characters and the checksum digit and has problems when they are not supplied back to them on handwritten documents (we trained the team to always write these extra numbers on the handwritten transfer docs.). We had a little training for the whole hospital when ISBT128 came out - flyers and posters, etc. - that warned the RNs and Drs that we wouild not be using the flag characters and the checksum digit. They adapted to that really quickly and we never have any questions on it. We are more likely to have a question on the pheresis split letters (A-G) for FFP than anything else - Meditech does show that letter. I can find any recalled/withdrawal/lookback unit in my system when asked to by my supplier - we just don't input the flag charcters and the checksum digit. Have not yet seen a problem or had a duplicate number or had an inspector even mention it. As long as you can find any unit you need and your system has not yet come up with any duplicate numbers (the whole purpose of ISBT128), I don't see the need to have the check digit on your paperwork. Good luck with CLIA. Let us know if they don't back down on the "requirement".

We were receiving a photocopy of the physician's orders from the chart, along with a photocopy of the consent form for every pickup. (Product orders print out on the Blood Bank printers when ordered.) It worked well for everyone but ER, who had a different computer system for order entry that they "could not" get copies of, so they asked to be exempted from the orders requirement. Now that we are getting to an Electronic Medical Record (EMR) setup for the rest of the hospital, we were told that the RNs could no longer give us a copy of the Dr's orders at pickup from the system without getting a whole chart printout (yikes!). (Others have said they could do a single screen print, but most don't know that. Supposedly, the ER is capable of that too, but they never picked up on it either.) So...in order to get the whole thing to work around the clock, we had the RNs go back to just bringing a small pickup form that identifies the pt, the BB ID band number and which product they want at the time. They also still bring the copy of the consent form. Annoyingly, many are still bringing the pickup slip without any product checked on it. Since the employee picking up is frequently not the individual hanging the unit, we have to call and ask what they want the person to pick up. If we wanted to see the orders, we would have to go into the computer (HCA Meditech 5.6.6) and find them. I resisted that on the basis that we still would not know what they wanted to pickup at any one time, but many times I can't get that from a simple checkoff form either! The EMR has made getting the patient's orders more difficult for us and the RNs. They had to build the transfusion orders on the product orders (so we do see some of them) so the RNs had some idea of when and how the Drs wanted the products given, but because the Dr's also wanted a "HOLD" option, they then had to build a separate TRANSFUSE order if they changed from Hold to Give (those we don't see). Our recent Joint inspector seemed happy and did not mention "how do WE know the RN has an order to give", so we are not checking that (yet!). Maybe it is a personal thing with some inspectors. I think that should be a Nursing responsibility and I think our RNs are double checking the order as they double check the unit(s) at the bedside before they hang them.

Makes more sense to point them towards their HIS - less chance of transcription errors that way too. Beside, when you call them - what are they doing with the information? Recording it anywhere or just saying "OK" and going on with their work? We only call babies with a positive DAT and that only because we need them to order some follow up work on the baby (cord bilirubin, etc).

Ju st to ask - how does one share a document now on this site? I don't see any attachment "paperclip" and when I tried one time to share something - i didn't have the time to figure out how. Any help would be appreciated.

We just finished getting ready for our first Joint Commission inspection and they have a standard the takes away the Dr's choice. Essentially - if the Blood Bank finds out about a transfusion problem - the transfusion reaction workup has to be done, period. QSA.05.18.01 section 2 - bullet 5 The requirement that suspected transfusion-related adverse events are reported immendiately to the laboratory, whether or not the physician responsible for the patient deems it necessary to report the event. This follows the requirement that the physician be notified too. I guess the Joint Commission decided to take the physician's decision out of the process too.

If you would do a search on this site - this has been discussed recently - might be several answers there for you. Email the web master if you need help.

Thanks, Terri - our charge master is due for an overview anyway - I can add that in now.

How do you get around the frequently clotted EDTA specimens when doing cord bloods on the ECHO? Do you wash the specimens before putting some cells on the instrument? Otherwise - does the ECHO wash the specimens enough for a valid DAT? Very curious - what is your method? We tried our ECHO with cords at first, but just had too many problems with clots. Went back to tubes for cord bloods. Thanks for any help and time.